Remnant cholesterol and the risk of incident type 2 diabetes: A community-based 14-year prospective cohort study

Table 1 Baseline characteristics of the study participants

Variable	Total (n = 7702)	Incident diabetes (-; n = 6008)	Incident diabetes (+; n = 1694)	P value
Age (years)	51.7 ± 8.8	51.3 ± 8.8	52.8 ± 8.5	< 0.001
Female	4089 (53.1)	3233 (53.8)	856 (50.5)	0.017
Current smoking	1917 (25.2)	1457 (24.6)	460 (27.4)	0.018
Heavy alcohol drink	732 (9.8)	541 (9.3)	191 (11.6)	0.007
Physical activity	4522 (59.7)	3533 (59.9)	989 (59.3)	0.652
Family history of diabetes	773 (10.0)	546 (9.1)	227 (13.4)	< 0.001
Hypertension	970 (12.6)	619 (10.3)	351 (20.7)	< 0.001
Hyperlipidemia	697 (9.1)	506 (8.4)	191 (11.3)	< 0.001
Cardiovascular disease	163 (2.1)	125 (2.1)	38 (2.2)	0.682
Chronic kidney disease	167 (2.2)	121 (2.0)	46 (2.7)	0.088
Fatty liver	1563 (20.4)	1005 (16.8)	558 (33.2)	< 0.001
eGFR (mL/minute/1.73 m2)	91.5 ± 16.7	91.6 ± 16.5	91.1 ± 17.3	0.235
Body mass index (kg/m2)	24.4 ± 3.1	24.2 ± 3.0	25.3 ± 3.2	< 0.001
Waist circumference (cm)	82.1 ± 8.7	81.4 ± 8.6	84.7 ± 8.6	< 0.001
Systolic blood pressure (mmHg)	120.5 ± 18.0	119.2 ± 17.7	124.9 ± 18.3	< 0.001
Diastolic blood pressure (mmHg)	79.9 ± 11.4	79.2 ± 11.3	82.5 ± 11.2	< 0.001
Fasting plasma glucose (mg/dL)	82.6 ± 8.5	81.5 ± 7.8	86.5 ± 9.7	< 0.001
Post-load glucose 120 minutes (mg/dL)	114.0 ± 30.0	108.4 ± 26.8	133.7 ± 32.6	< 0.001
Fasting serum insulin (μIU/mL)	7.55 ± 4.78	7.44 ± 4.72	7.95 ± 4.96	< 0.001
Glycated hemoglobin	5.54 ± 0.34	5.49 ± 0.32	5.74 ± 0.34	< 0.001
Total cholesterol (mg/dL)	189.3 ± 34.0	187.9 ± 34.0	194.2 ± 33.7	< 0.001
HDL-C (mg/dL)	45.0 ± 10.1	45.5 ± 10.1	43.2 ± 9.7	< 0.001
Triglycerides (mg/dL)	152.7 ± 84.1	144.4 ± 77.5	182.1 ± 98.8	< 0.001
Sampson-NIH2 LDL-C (mg/dL)	117.2 ± 30.8	116.7 ± 30.8	119.0 ± 30.7	0.006
Non-HDL-C (mg/dL)	144.3 ± 33.2	142.4 ± 33.1	151.0 ± 33.0	< 0.001
Remnant cholesterol (mg/dL)	27.1 ± 13.9	25.7 ± 12.8	32.0 ± 16.2	< 0.001
Blood urea nitrogen (mg/dL)	14.3 ± 3.6	14.2 ± 3.6	14.4 ± 3.7	0.022
Creatinine (mg/dL)	0.84 ± 0.19	0.84 ± 0.19	0.85 ± 0.20	0.042
Aspartate aminotransferase (U/L)	29.1 ± 16.8	28.7 ± 17.0	30.5 ± 15.0	< 0.001
Alanine aminotransferase (U/L)	26.9 ± 21.7	25.7 ± 19.6	31.0 ± 27.6	< 0.001
γ-glutamyl transpeptidase (U/L)	31.9 ± 58.0	28.5 ± 42.4	44.0 ± 93.5	< 0.001

Data are shown as mean ± SD or n (%). eGFR: Estimated glomerular filtration rate; HDL-C: High density lipoprotein cholesterol; LDL-C: Low density lipoprotein cholesterol.

Table 2 Association of remnant cholesterol with incident type 2 diabetes

Model	Total cholesterol	Triglycerides	Sampson-NIH2 LDL-C	Non-HDL cholesterol	Remnant cholesterol
1	1.20 (1.14-1.26)	1.35 (1.30-1.39)	1.08 (1.03-1.14)	1.27 (1.22-1.34)	1.36 (1.31-1.40)
2	1.19 (1.13-1.24)	1.34 (1.29-1.38)	1.08 (1.03-1.13)	1.26 (1.20-1.32)	1.35 (1.30-1.40)
3	1.10 (1.05-1.16)	1.25 (1.20-1.30)	1.02 (0.97-1.07)	1.15 (1.10-1.21)	1.26 (1.21-1.31)
4	1.04 (0.99-1.09)	1.25 (1.20-1.30)	0.97 (0.92-1.02)	1.10 (1.04-1.16)	1.25 (1.20-1.30)

Data are expressed as HRs with 95%CIs. Model 1: Crude; Model 2: Adjusted for age and sex; Model 3: Adjusted for variables in Model 2 plus body mass index, waist circumference, systolic blood pressure, current smoking, heavy alcohol consumption, physical activity, and family history of diabetes; Model 4: Adjusted for variables in Model 3 plus fasting plasma glucose, fasting serum insulin, estimated glomerular filtration rate, and alanine aminotransferase. HDL-C: High density lipoprotein cholesterol; LDL-C: Low density lipoprotein cholesterol.

Table 3 Comparison of predictive performance of lipid parameters for incident type 2 diabetes

	All (n = 7304)	Triglyceride < 400 mg/dL (n = 7172)	Triglyceride ≥ 400 mg/dL (n = 132)
IDI
Remnant cholesterol vs triglycerides	0.001 (-0.005 to 0.006)	-0.001 (-0.007 to 0.004)	0.004 (-0.053 to 0.049)
Remnant cholesterol vs non-HDL-C	0.033 (-0.038 to 0.093)	0.050 (0.015-0.120)	-0.006 (-0.110 to 0.085)
NRI
Remnant cholesterol vs triglycerides	0.061 (-0.433 to 0.567)	0.076 (-0.471 to 0.478)	0.542 (-1.306 to 1.797)
Remnant cholesterol vs non-HDL-C	0.351 (-0.127 to 0.699)	0.534 (0.096-0.882)	-0.470 (-1.758 to 0.990)

Data are expressed as indices with 95%CIs. Comparisons are based on Model 4 for each lipid parameter. IDI: Integrated discrimination index; HDL-C: High density lipoprotein cholesterol; NRI: Net reclassification improvement.